|
Cesarean Section Without Sterilization With CC
|
Facility
IP
|
$9,602.26
|
|
|
Service Code
|
MS-DRG 787
|
| Hospital Charge Code |
529
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,602.26 |
| Rate for Payer: Amerigroup Medicaid |
$9,555.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,463.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,602.26
|
|
|
Cesarean Section Without Sterilization With MCC
|
Facility
IP
|
$11,203.62
|
|
|
Service Code
|
MS-DRG 786
|
| Hospital Charge Code |
528
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$11,203.62 |
| Rate for Payer: Amerigroup Medicaid |
$11,149.49
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11,041.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,203.62
|
|
|
Cesarean Section Without Sterilization Without CC/MCC
|
Facility
IP
|
$8,554.05
|
|
|
Service Code
|
MS-DRG 788
|
| Hospital Charge Code |
530
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,554.05 |
| Rate for Payer: Amerigroup Medicaid |
$8,512.72
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,430.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,554.05
|
|
|
Cesarean Section With Sterilization With CC
|
Facility
IP
|
$9,088.49
|
|
|
Service Code
|
MS-DRG 784
|
| Hospital Charge Code |
526
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,088.49 |
| Rate for Payer: Amerigroup Medicaid |
$9,044.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,956.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,088.49
|
|
|
Cesarean Section With Sterilization With MCC
|
Facility
IP
|
$11,362.09
|
|
|
Service Code
|
MS-DRG 783
|
| Hospital Charge Code |
525
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$11,362.09 |
| Rate for Payer: Amerigroup Medicaid |
$11,307.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11,197.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,362.09
|
|
|
Cesarean Section With Sterilization Without CC/MCC
|
Facility
IP
|
$8,057.98
|
|
|
Service Code
|
MS-DRG 785
|
| Hospital Charge Code |
527
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,057.98 |
| Rate for Payer: Amerigroup Medicaid |
$8,019.05
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,941.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,057.98
|
|
|
cetirizine 10 mg Tab
|
Facility
IP
|
$1.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43761782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
|
|
cetirizine 10 mg Tab
|
Facility
OP
|
$1.56
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43761782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Aetna of IA Medicare |
$0.89
|
| Rate for Payer: Amerigroup Medicaid |
$0.79
|
| Rate for Payer: Amerigroup Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.78
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.17
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.92
|
|
|
cetirizine 5mg/5ml 120 ml bottle
|
Facility
OP
|
$15.20
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43720136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna of IA Commercial |
$13.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.68
|
| Rate for Payer: Aetna of IA Medicare |
$8.66
|
| Rate for Payer: Amerigroup Medicaid |
$7.67
|
| Rate for Payer: Amerigroup Medicare |
$7.68
|
| Rate for Payer: Cash Price |
$12.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.40
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.60
|
| Rate for Payer: Medical Associates Commercial |
$11.40
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.60
|
| Rate for Payer: Midlands Choice Commercial |
$10.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.40
|
| Rate for Payer: United Healthcare Commercial |
$13.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.97
|
|
|
cetirizine 5mg/5ml 120 ml bottle
|
Facility
IP
|
$15.20
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43720136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna of IA Commercial |
$13.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.68
|
| Rate for Payer: Cash Price |
$12.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.40
|
| Rate for Payer: Medical Associates Commercial |
$11.40
|
| Rate for Payer: Midlands Choice Commercial |
$10.64
|
| Rate for Payer: United Healthcare Commercial |
$13.68
|
|
|
cevimeline 30 mg Cap
|
Facility
IP
|
$4.33
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43720015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of IA Commercial |
$3.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.90
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.25
|
| Rate for Payer: Medical Associates Commercial |
$3.25
|
| Rate for Payer: Midlands Choice Commercial |
$3.03
|
| Rate for Payer: United Healthcare Commercial |
$3.90
|
|
|
cevimeline 30 mg Cap
|
Facility
OP
|
$4.33
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43720015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of IA Commercial |
$3.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.90
|
| Rate for Payer: Aetna of IA Medicare |
$2.47
|
| Rate for Payer: Amerigroup Medicaid |
$2.19
|
| Rate for Payer: Amerigroup Medicare |
$2.19
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.16
|
| Rate for Payer: Medical Associates Commercial |
$3.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.16
|
| Rate for Payer: Midlands Choice Commercial |
$3.03
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.25
|
| Rate for Payer: United Healthcare Commercial |
$3.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.55
|
|
|
CHANGE GASTROSTOMY TUBE
|
Professional
|
$1,621.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
7822793
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$1,134.70 |
| Rate for Payer: Cash Price |
$1,296.80
|
| Rate for Payer: Cash Price |
$1,296.80
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,134.70
|
| Rate for Payer: Wellmark IA HMO |
$81.00
|
| Rate for Payer: Wellmark IA PPO |
$99.00
|
|
|
CHANGE OF BLADDER TUBE
|
Professional
|
$302.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
7822797
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$46.96 |
| Max. Negotiated Rate |
$211.40 |
| Rate for Payer: Aetna of IA Medicare |
$46.96
|
| Rate for Payer: Amerigroup Medicaid |
$48.56
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.90
|
| Rate for Payer: Medical Associates Commercial |
$89.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.96
|
| Rate for Payer: Midlands Choice Commercial |
$211.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$70.44
|
| Rate for Payer: Wellmark IA HMO |
$97.00
|
| Rate for Payer: Wellmark IA PPO |
$114.00
|
|
|
CHEMO ANTI-NEOPL SQ/IM
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
8398093
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$73.47 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of IA Commercial |
$132.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.30
|
| Rate for Payer: Aetna of IA Medicare |
$83.79
|
| Rate for Payer: Amerigroup Medicaid |
$74.19
|
| Rate for Payer: Amerigroup Medicare |
$74.24
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.47
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.73
|
|
|
CHEMO ANTI-NEOPL SQ/IM
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
8398093
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of IA Commercial |
$132.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.30
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.25
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
|
|
CHEMO CNS INTRATHECAL W LP
|
Facility
OP
|
$435.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
8398092
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$217.41 |
| Max. Negotiated Rate |
$609.03 |
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Aetna of IA Commercial |
$391.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$391.50
|
| Rate for Payer: Aetna of IA Medicare |
$247.95
|
| Rate for Payer: Amerigroup Medicaid |
$219.54
|
| Rate for Payer: Amerigroup Medicare |
$219.68
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$326.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$217.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$217.41
|
| Rate for Payer: Medical Associates Commercial |
$326.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$217.50
|
| Rate for Payer: Midlands Choice Commercial |
$304.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$220.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$326.25
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$256.65
|
| Rate for Payer: Wellmark IA HMO |
$553.66
|
| Rate for Payer: Wellmark IA PPO |
$609.03
|
|
|
CHEMO CNS INTRATHECAL W LP
|
Facility
IP
|
$435.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
8398092
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Aetna of IA Commercial |
$391.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$391.50
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$326.25
|
| Rate for Payer: Medical Associates Commercial |
$326.25
|
| Rate for Payer: Midlands Choice Commercial |
$304.50
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
|
|
CHEMO INFUSION
|
Facility
OP
|
$579.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
8378850
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$289.38 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$521.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$521.10
|
| Rate for Payer: Aetna of IA Medicare |
$330.03
|
| Rate for Payer: Amerigroup Medicaid |
$292.22
|
| Rate for Payer: Amerigroup Medicare |
$292.40
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$434.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$289.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$289.38
|
| Rate for Payer: Medical Associates Commercial |
$434.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$289.50
|
| Rate for Payer: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$293.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$434.25
|
| Rate for Payer: United Healthcare Commercial |
$521.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$341.61
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
CHEMO INFUSION
|
Facility
IP
|
$579.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
8378850
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$405.30 |
| Max. Negotiated Rate |
$521.10 |
| Rate for Payer: Aetna of IA Commercial |
$521.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$521.10
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$434.25
|
| Rate for Payer: Medical Associates Commercial |
$434.25
|
| Rate for Payer: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: United Healthcare Commercial |
$521.10
|
|
|
CHEMO IV EA ADD'L HR
|
Facility
OP
|
$435.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
8378852
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$217.41 |
| Max. Negotiated Rate |
$609.03 |
| Rate for Payer: Aetna of IA Commercial |
$391.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$391.50
|
| Rate for Payer: Aetna of IA Medicare |
$247.95
|
| Rate for Payer: Amerigroup Medicaid |
$219.54
|
| Rate for Payer: Amerigroup Medicare |
$219.68
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$326.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$217.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$217.41
|
| Rate for Payer: Medical Associates Commercial |
$326.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$217.50
|
| Rate for Payer: Midlands Choice Commercial |
$304.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$220.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$326.25
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$256.65
|
| Rate for Payer: Wellmark IA HMO |
$553.66
|
| Rate for Payer: Wellmark IA PPO |
$609.03
|
|
|
CHEMO IV EA ADD'L HR
|
Facility
IP
|
$435.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
8378852
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Aetna of IA Commercial |
$391.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$391.50
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$326.25
|
| Rate for Payer: Medical Associates Commercial |
$326.25
|
| Rate for Payer: Midlands Choice Commercial |
$304.50
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
|
|
CHEMO IVF EA ADD'L SEQ
|
Facility
IP
|
$347.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
8378854
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Aetna of IA Commercial |
$312.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$312.30
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$260.25
|
| Rate for Payer: Medical Associates Commercial |
$260.25
|
| Rate for Payer: Midlands Choice Commercial |
$242.90
|
| Rate for Payer: United Healthcare Commercial |
$312.30
|
|
|
CHEMO IVF EA ADD'L SEQ
|
Facility
OP
|
$347.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
8378854
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$173.43 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Aetna of IA Commercial |
$312.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$312.30
|
| Rate for Payer: Aetna of IA Medicare |
$197.79
|
| Rate for Payer: Amerigroup Medicaid |
$175.13
|
| Rate for Payer: Amerigroup Medicare |
$175.24
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$260.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$173.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$173.43
|
| Rate for Payer: Medical Associates Commercial |
$260.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$173.50
|
| Rate for Payer: Midlands Choice Commercial |
$242.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$176.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$260.25
|
| Rate for Payer: United Healthcare Commercial |
$312.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$204.73
|
|
|
CHEMO IVF EA ADD'L SEQ INF
|
Facility
OP
|
$347.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
8378853
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$173.43 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$312.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$312.30
|
| Rate for Payer: Aetna of IA Medicare |
$197.79
|
| Rate for Payer: Amerigroup Medicaid |
$175.13
|
| Rate for Payer: Amerigroup Medicare |
$175.24
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$260.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$173.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$173.43
|
| Rate for Payer: Medical Associates Commercial |
$260.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$173.50
|
| Rate for Payer: Midlands Choice Commercial |
$242.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$176.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$260.25
|
| Rate for Payer: United Healthcare Commercial |
$312.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$204.73
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
